Lifestyle Medicine Is the Standard of Care for Prediabetes

Image Credit: Alden Chadwick / Flickr. This image has been modified.

How to Treat Prediabetes with Diet

For people with prediabetes, lifestyle modification is considered “the cornerstone of diabetes prevention.” Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association’s official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3’s, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it’s safe and highly effective, why don’t more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren’t getting paid to do it. Why haven’t reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

“The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?”

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education “has not changed since 1910.”


 

I hope my work is helping to fill the gap with the information about preventing and treating chronic disease that medical professionals are not getting during training. That’s actually how this all started. I would make trips to Countway Library of Medicine at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I’m doing so much work, might as well share it! So, what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


68 responses to “How to Treat Prediabetes with Diet

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  1. Is the risk reduction for T2D and pre-diabetes associated with consuming whole grains in relation to refined grains or to no grains.

    1. Thanks for your question!

      According to the study mentioned Dr Greger, ” risk of deteriorating glucose tolerance decreased by 20% per 60 g whole-grain intake/day”. Looking the study, it seems that they only calculated whole grain intake using a food frequency questionnaire and therefore it seems intake of refined grains was not calculated and no conclusion can be made in regards to that. The study demonstrated that “higher whole-grain intake is associated with decreased risk of deteriorating glucose tolerance, especially the progression from normal glucose tolerance to pre diabetes.”

      Hope this answer helps!

    2. Such a good question, cyndirk. Whole grains instead of what shows an improvement in glucose tolerance? If whole grains are replacing sugar or dairy fat or meat or processed grain, it doesn’t tell us much.

    3. As I understand it, the studies only show the difference between eating whole grains in various quantities and not eating whole grains. We do not know what foods the whole grains substituted for.
      Regarding T2D, there was also a 2010 study of omen with diabetes. It found
      “Our results indicated that intakes of whole grain especially its subcomponent bran were inversely associated with all-cause and CVD-specific mortality among women with type 2 diabetes. Low whole grain intake may be considered an important modifiable risk factor for decreasing mortality and cardiovascular risk in persons with diabetes.”
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886277/

      Given that whole grain consumption is associated with ,lower mortality in general, it seems like a good idea to include whole grains in the diet whatever dubious, sensationalist fad diet books might claim.
      “These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.”
      http://archinte.jamanetwork.com/article.aspx?articleid=2087877

      1. Thanks, Tom. I’m not opposed to eating grains, but I’m what I call pre-pre-diabetic–quite normal, middle of the range, fasting numbers, but I have to eat grains rather sparingly, and then it’s quinoa or hulled barley in small portions or I have issues. The only person I’ve heard address this question is the Wheat Belly author, and I’m not inclined to consider him an especially credible source.

        1. I have to agree with you there but am not sure why you “have to eat grains rather sparingly.” As far as I know, for most people at least, whole grains are beneficial. Certainly, the standard advice for people with pre-diabetes is to cut back on total calories consumed and saturated fat consumption and “Eat foods such as vegetables, fruits, whole grains,……………..”
          http://familydoctor.org/familydoctor/en/diseases-conditions/prediabetes.printerview.all.html
          http://professional2.diabetes.org/content/PML/All_About_Prediabetes_24dee6ff-cbf0-4a55-80b7-9d5d29de0bd7/All_About_Prediabetes.pdf

          More generally, this review from back in 2004 is an interesting discussion of the whole topic.
          http://www.nature.com/ejcn/journal/v58/n11/full/1601995a.html

          1. Very interesting! And it’s exactly the advice I used to give my older diabetic relatives before my own insulin resistance showed up. I’ve been experimenting for 5 years, and grains, even whole grains, raise my glucose levels into an unhealthy range. I can only handle small servings, and I wonder if it’s worth the effort. That’s the reason for my question. Should I design my plate around a couple tablespoons of grains or not bother? I’m quite aware of the standard plant-based advice to consume them. I have similar issues with other starches like corn and even sweet potatoes. I don’t think these are bad foods, just maybe not great for me.

              1. Thanks re the pic, lemonhead! 5 years ago I could eat up to two cups of beans without little adverse glucose issues, but I’m more inconsistent now. 1/2 cup serving barely registers but more and it’s unpredictable. I fear I’m deteriorating even though my fasting levels are still low-mid 80s.

            1. Yes, I was going to make the same suggestion as lemonhead ie go for beans, peas, wholegrain pasta on the basis of the standard advice given to diabetics.
              “Many starchy foods (such as breads, cereals, potatoes, and rice) have a high glycemic index; they digest easily and convert into blood glucose quickly. However, some starchy foods (such as pasta, beans, and peas) have lower glycemic index values.”
              http://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/strike-the-spike-ii/

              I do not have a diabetes problem but I do eat my morning oatmeal 50:50 with oatbran (plus berries etc to taste). That should reduce any glucose spike and it definitely provides satiety.

              The other option you could consider is make a virtue of a necessity and eat multiple small meals throughout the day. Make them in advance perhaps, to minimise hassle, and then microwave them as needed. Of course I recognise that that is not always practical depending on people’s personal circumstances.

              Certainly, McDougall appears to have considerable success with diabetes patients using precisely these foods. You might try going to his website and perhaps raising the question there of post prandial glucose spikes.

              1. Hi Marcia. I think there are many of us out there! We may be the lucky ones because at least we are aware there is an issue. The only other factors I’m sure of are my crappy genes, and I really dislike blaming them. My mother was diagnosed at about 60 with diabetes and fasting glucose levels over 300. While she was able to bring that down, the diabetes was never well controlled. I’m 57, and I would sincerely like to avoid her fate. Weight was never an issue for either of us, so I do become a bit annoyed when T2D is routinely called a disease of obesity. Also, I’ve been vegan for 12 years (if I haven’t already stated that). What I know is that grains are not my good friends, legumes are questionable, and I’m still consuming them, and exercise seems to help tremendously. After meal numbers drop like a stone after a fast 45-60 minute walk. One other thing I find curious is that, lately I’ve been testing at about 1 hour as well as 2 hours after meals. At least 75% of the time, numbers are higher, sometimes significantly, at 2 hours. No one can give me a good explanation for that. Since, I’m maintaining numbers shy of the official pre-diabetic range, my doctors just have a “whatever” attitude about that. Please share if you can think of other factors to consider.

                1. Way too complicated for me to figure out. The human body is a very complex thing, making me think that the standard advice given by docs even today, “reduce carbs and exercise,” surely can’t be right for everyone. Even nutritionists, from what I’ve seen recently, don’t agree on what a “good” diet is. It’s hard trying to sort it all out.

  2. I had a brief brush with heart issues last year. Since then I’ve lost 45 lb and am exercising regularly. If you lose enough weight and work out regularly, you will greatly reduce your risk of diabetes and heart disease. For me, preferred exercise is long-distance slow speed aerobics, not “Insane” or “The Navy SEAL Work-Out”. Eat more greens, fiber, and lean protein, and watch the junk food. On the advice of my primary-care doctor, I also supplement with Chromium Picolinate which helps improve my body’s use of insulin.

    1. When you eat plants you are eating protein. No need to specifically seek out protein and point to something distinct on your plate as being your “protein”. Just eat whole foods, cut out the refined sugars and refined oils, and protein will naturally take care of itself.

      And if by “lean protein” you mean any type of meat, I think you would be shocked at the percentage of calories even in supposedly lean meats like chicken breasts or pork chops, which even with skin and fat removed still get 22% and 36% of their calories from fat. And if you don’t discard the skin or trim all the visible fat off, those percentages jump to 36% and 41%. And as for “lean” ground beef (93% lean) gets 40% of its calories from fat. So much for lean. By contrast cooked black beans for example only gets 4% of calories from fat.

      So in the meat world “lean” protein is a marketing ploy rather than anything meaningful.

  3. I loved the Countway also studying Medicine in Boston, especially the skull of Phineas P. Gage. I thank you for your hard work. I gradually became vegan with my HbA1c dropping from 5.7 to 5.0.

    1. Congratulations, Robert, on YOUR hardwork bringing that A1c down! Glad your’re benefiting from NutritionFacts.org and your lowered A1C confirms it.

  4. Another great source of information on prediabetes. I have learned so much from your website and am so grateful. Was recently tested as prediabetic despite a lack of family history, a pescetarian diet, healthy lifestyle with lots of exercise and maybe 5 lbs overweight. Thanks to all the information I have gleaned here I will be including flaxseed in my diet every day, increasing my bean intake substantially, increasing whole grains and decreasing my egg, dairy and fish intake (unless my next test tells me moderation is not sufficient in which case no fish, no dairy, no eggs). Working at this from a lifestyle perspective is so much more appealing – far better than assuming this must turn into diabetes and therefore I may as well start diabetes meds today (as suggested by my doctor). So thank you for the insights and information – you have certainly helped me better understand this disease and made me a better patient for it (and hopefully a healthier human).

    1. Daisy, indeed working towards whole food plant based nutrition does indeed give us hope we have control rather than just sliding towards chronic conditions. And you’re to be commended on your proactive approach. Instead of just mentioning “I’ll eat better, you spelled out -doable, measurable steps you can indeed take to lower your diabetes risk. Keep up the good work.

  5. I think that flaxseed study (PMID 23684438) was misquoted. Better results were obtained in the group eating 13 grams or one tablespoon a day, not two.

      1. My kitchen scale says 1 tbsp wholeflax weighs 14 grams. The online converter says 13 grams is equal 2.6 teaspoons and 3 teaspoons is one tablespoon.

        1. The gram is a unit of weight; the teaspoon, or the tablespoon, is a unit of volume. So, the conversion of a given amount of a substance from grams to tea- or tablespoons must include its density. Can the online converter you use do that, without your having to input the density? If it can, please let me know what it is, because my kitchen scale can not measure the weight of a small amount, like 1 teaspoon, accurately. Thanks.

          1. I think the density would depend on whether the flaxseed was ground or whole seed. That might be another factor to consider.

        2. I haven’t measured, but when I grind flax seeds they greatly increase in volume. Next time I grind some I’ll measure weights and volumes before and after. It won’t be scientifically accurate, but it will give a ballpark idea of how volume increases with grinding.

  6. Does this all mean alot more fibre? Is the starch diet discussed by Dr. Mcdougall good for getting out of pre-diabetes?

    1. Yes, according to some research examined by Dr. Greger, reducing saturated fat content and added oils increases one’s sensitivity to insulin. McDougall claims to have successfully treated patients with diabetes by having those follow a starch-based diet. He says even those eating white rice or refined carbohydrates have noticed improvements in their health, but McDougall recommends whole foods which means whole grains, brown rice, corn, potatoes, oats. I recommend eating foods high in fiber as those will be the most satiating. I find a nice bowl of oatmeal with raisins and some flax seed meal keeps me well-satisfied until lunch. In fact, I often end up getting lunch later.

  7. This article raises a couple of interesting questions. I have been a vegan for just over a year. Prior to that I was largely plant-based, but happily leapt off the wagon at any possible moment. Also, this year I focused on “cleaning up” my diet to get a wider variety of foods introduced. The results are encouraging – last cholesterol was 138. HDL was low – working on that – but LDL and triglycerides were in range. Anyway, while I was discussing this with my doctor – who is very pro-vegan (that’s why I switched to him) – he suggested, considering my weight, glucose level (in the 90s), and A1C (normal), that I may have developed some level of insulin intolerance. So my questions are:

    1. Can diet reverse insulin intolerance? Or do you just have to live with it once it’s developed?
    2. Is it true that insulin intolerance causes people to crave more food? (I saw that on another web site.)

    A bonus question: While I was talking to my doctor, he mentioned that there are some doctors who believe that healthy vegans (I’m working on that) may have unusually low HDL levels simply because their other measures are also low. Any thoughts on that?

    Thanks,
    Kevin

    1. Hi Kevin,

      Thanks for the great questions!

      1) Here’s a video by Dr. G that addresses the issue of insulin intolerance. It appears that a low fat WFPB diet is just the ticket you’re looking for!

      Insulin Resistance

      2) There is data to support the idea that insulin resistance increases food cravings- check out the articles referenced below.

      Ania M. Jastreboff, Rajita Sinha, Cheryl Lacadie, Dana M. Small, Robert S. Sherwin, Marc N. Potenza. Neural Correlates of Stress- and Food Cue–Induced Food Craving in Obesity: Association with insulin levels. Diabetes Care. 2013 February; 36(2): 394–402.

      Gao Q, Horvath TL. Neurobiology of feeding and energy expenditure. Annu Rev Neurosci 2007;30:367–398

      Anthony K, Reed LJ, Dunn JT, et al. Attenuation of insulin-evoked responses in brain networks controlling appetite and reward in insulin resistance: the cerebral basis for impaired control of food intake in metabolic syndrome? Diabetes 2006;55:2986–2992

      3) There have been several studies looking at HDL in vegetarians and even some in vegans. However, it is hard to determine how relevant these are to a WFPB diet – one study even noted “The vegans consumed relatively small amounts of fruit, berries, nuts, and root vegetables,” and high amounts of margarine. Note exactly what Dr. G recommends. That being said, there is data to suggest that vegans have lower total cholesterol, lower LDL cholesterol AND lower HDL cholesterol than non-vegans.

      One thing that is important to look at though, beyond just the numbers, is the ratio of total cholesterol to HDL. This ratio should, ideally, be less than 3.5. If it makes you feel any better, my HDL is always low too! But my total cholesterol is so low that my TC/HDL ratio is great, so I don’t spend too much time worrying about it. :)

      Vegans and HDL studies:
      Barnard ND et al. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol 2000; 85:969–972.

      De Biase SG et al. Vegetarian diet and cholesterol and triglycerides levels. Arq Bras Cardiol 2007; 88(1): 35-39.

      Elorinne, Georg Alfthan, Iris Erlund, Hanna Kivimäki, Annukka Paju, Irma Salminen, Ursula Turpeinen, Sari Voutilainen, Juha Laakso. Food and Nutrient Intake and Nutritional Status of Finnish Vegans and Non-Vegetarians.

      PLoS One. 2016; 11(2): e0148235.

      Jenkins DJA et al. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med 2009;169(11):1046-1054.

      Key TJ et al. Health effects of vegetarian and vegan diets. Proceedings of the Nutrition Society 2006; 65: 35–41.

      Toohey ML et al. Cardiovascular disease risk factors are lower in African-American vegans compared to lacto-ovo-vegetarians. Journal of the American College of Nutrition 1998; 17 (5): 425–434.

      Waldmann A et al. German vegan study: diet, life-style factors, and cardiovascular risk profile. Ann Nutr Metab 2005; 49(6): 366-372.

  8. “There is something rotten in the state of Denmark” Quote from Hamlet – Shakespeare. This is the way I feel about “the system” we have developed here in the United States. Here is how the system has failed us. In preschool daycare they feed us junk, candy, and ice cream. They force us to get vaccinated with only God knows what. In Elementary school they teach us the food pyramid and how important drinking milk, eating eggs, and eating meat is “good” for us. As kids we are propagandized by commercials during cartoon time to eat “junk” cereal foods. Everywhere we go as children all we see are the golden arches of McDonalds, Burger King, In and Out Burgers, Jack In The Box, Papa John’s Pizza, Taco Bell, Chuckie Cheese Pizza, Red Lobster, Golden Corral, Long John Silver, and the list could just go on and on and on….but let’s not forget 31 Flavors Ice Cream Parlor. Then in Jr. High School we are taught in health class that drinking milk is good for our growing bodies, and a high protein diet is necessary if you want to build those muscles. The indoctrination continues even into high school, and college. During the educational process there is NOT one teacher who will tell you that meat has many negative effects on your health. During these formative years there is NOT one dentist who will tell you that MILK will actually degrade your bone and calcium levels. And, when you do go to the doctor there is NOT one doctor that will teach you about the benefits of a whole plant food diet. Meanwhile, researchers at the university level make all of these discoveries about the benefits of whole plant food diet, and they do not go out and SHOUT IT FROM the roof tops, except for a very minute handful of brave men like Greger, Esselstyn, Ornish, Pritikin, Fuhrman, and some others. The system has let us down. The system has slowly poisoned us with their meats, additives, pollution, dairy products, eggs, and processed foods and TONS of sugar in every thing we see in the food aisles. And then we have the PERSECUTION of good people who try to share the light of truth in regards to a whole plant food diet. I don’t want to go into that…but…anyone reading this knows about it. And then we have the DISTRACTORS like the leaders of the Atkins diet, the Paleo Diet. The system has let us down…..all for the love of money.

    1. It gets worse when you realize our tax dollars subsidize factory “farming” of animals, GMO crops of corn and soy, and all the toxins that go with that model. Yet farmers who grow organic vegetables, fruits, grains, nuts and seeds, instead of being subsidized, must pay extra for certification that they are farming organically.

    2. That is great that you have come to this realization and knowing who is providing the correct information regarding health and life style and you continue following Dr Greger.

  9. I looked for a recent meta-analysis from 2015 and found one on saturated fats and type 2 diabetes. Here is what they said in their abstract: ” CONCLUSIONS:

    Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations ” http://www.ncbi.nlm.nih.gov/pubmed/26268692

    1. Yes, that is because it is a meta analysis of observational studies. Observational studies are subject to all sorts of confounders. For example, people in Western societies not eating saturated fats are usually eating junk carbs instead – chips/fries, white bread, pasta, sugary breakfast cereals and other processed foods. These are just as unhealthy as saturated fats. It is therefore no surprise that meta analyses of saturated fat consumption find no association between saturated fat consumption and mortality etc.
      However, a different story emerges when properly designed experimental studies are considered. Randomised controlled trails are considered a much stronger form of evidence than observation studies. This meta analysis you refer to also explicitly noted:
      “A meta-analysis of randomized trials suggested a 17% reduction in risk of CVD in studies that reduced saturated fat intake from about 17% to about 9% of energy”
      As your meta analysis itself notes “Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats.”
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752/

      In considering matters like this, it is important not only to consider the findings of observational studies but also those from experimental studies and the role of known effects of nutrients on eg the human cardiovascular system. The US National Evidence Library contains an evidence summary of the role of saturated fat in type 2 diabetes and heart disease;
      “Strong evidence indicates that dietary saturated fatty acids (SFA) are positively associated with intermediate markers and end-point health outcomes for two distinct metabolic pathways: 1) increased serum total cholesterol (TC) and LDL cholesterol (LDL-C) and increased risk of cardiovascular disease (CVD) and 2) increased markers of insulin resistance and increased risk of type 2 diabetes (T2D). Conversely, decreased SFA intake improves measures of both CVD and T2D risk. The evidence shows that a five percent energy decrease in SFA, replaced by monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA), decreases risk of CVD and T2D in healthy adults and improves insulin responsiveness in insulin resistant and T2D subjects.”
      http://www.nel.gov/evidence.cfm?evidence_summary_id=250189

      1. The gorilla in the room is the incredible damage the highly processed unsaturated fats like soybean oil or corn oil do in terms of causing low level chronic inflammation. They are outside the realm of evolutionary adaptation. My concern is many people will think to utilize unsaturated fats , in general, to address the health matters raised by Dr. Greger.
        I could refer to the references from Mark Hymans recent book ” Eat Fat, Get Thin, Why the Fat We Eat is the key to sustained weight loss and vibrant health” or to the exhaustive research over many years by Nina Teicholz.
        More relevant, for me, are the practical results of eliminating all grains and dairy and resorting to a ancestral diet that we evolved to be prepared for ( like with suitable enzymes ). Dr. Terry Wahls has charts in her book showing the nutrition supplied to the cells when grains and dairy are replaced with a modified paleo-ketogenic diet.( nutrition the cells can thrive on, not just survive on ) Dr. Seignalet tested his protocol on 2500 volunteers over 20 years and found with 91 diseases there was a substantial measurable improvement ( over 80% ) and many diseases went into complete remission ( no grains and no dairy ).
        I hope in the pursuit of the truth we will not cherry pick results so as to just win an argument. The meta-analysis was not ” mine “, but just the first substantial result from a general search for recent reviews. Because of the observational aspect it is certainly not the bedrock for my decision making of what to eat and what to feed my children. For that I look to Dr.Wahls, Dr. Seignalet, Dr. Natasha Campbell-McBride, and Dr. Valter Longo-amongst many.

        1. I think that the quality and credibility of the sources you use is vitally important. You mentioned Nina Teicholz. She is a reporter who is selling a sensational book that contains a lot of falsehoods, misinterpretations of the evidence and significant omissions of evidence that disproves her claims

          1. Two of the most respected scientists ( and practicing physicians )are Dr. Terry Wahls and Dr. Seignalet of France ( passed away ). If you would take the time to look at what they have accomplished I think you would change your mind.
            I could pick apart the mistakes Dr. Greger has made and then completely invalidate his contributions, which are numerous and quite substantial ( IMHO ). But that would just be nitpicking so as to win an argument, not make headway in getting at the truth.

            1. I have looked at Terry Wahls’ stuff before. As far as I can remember, her dietary theory is substantiated solely by her claimed personal experience. I note that she is also profiting from selling books and other products. As a blogger commented:
              ” A number of people have sent me links to this opinion piece, and other articles about Dr. Terry Wahls, who claims to have cured her own multiple sclerosis (MS) with diet alone. She advocates a paleo-style diet to cure whatever ails you. The evidence for this claim – zippo.”
              http://theness.com/neurologicablog/index.php/can-diet-cure-ms/

              As for Dr Seignalet, his book is apparently not available in English. However, I understand that his approach is based on a theory rather than actual experimental evidence. I note also that ,despite the health claims he made for his diet, he passed away at only 67.

              All of these paleo diet approaches tell a great story but basically have no real evidence to support them. They assume that, because something was eaten in the paleolithic, it must automatically be healthy. And if is a modern food, it must automatically be unhealthy. These assumptions are non-sequiturs and not supported by any real evidence. Sure, highly processed modern food are unhealthy. That is what the evidence shows. But wheat and other whole grains?
              ” These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.”
              http://archinte.jamanetwork.com/article.aspx?articleid=2087877

              Personally, I would prefer to go with what the science shows rather than with somebody’s pet theory claims. These paleo diet theories remind me of Thomas Huxley’s words
              “Science is organized common sense where many a beautiful theory was killed by an ugly fact.”

              1. Dr. Terry Wahls did get the funding for clinical trials and at least one of them is complete. She was a vegetarian for 10 years and then paleo for 2 years. With a highly modified paleo, ketogenic diet she accomplished a remarkable recovery, as the people who used to watch her make her rounds in a gravity wheelchair can testify to. For her cells to perform optimally, not just get by, they are supplied with 6 cups of vegetables per day. When she was able to travel to conferences at a certain point, and stopped eating the 6 cups of vegetables, the MS returned and she was forced to bring big zip lock bags in a cooler when she traveled ( 3 leafy green, 3 high sulfur, 3 bright and colorful -for a man, ), Plus 1 -2 cups of homemade bone broth every day. You seem like a capable person Tom Goff- her videos are available on youtube.
                Dr. Seignalet published over 200 papers in peer reviewed journals and two books are available in English. One book is written by a woman who was in charge of a research lab in Montreal for 17 years. Dr. Seignalet collected data on 2500 volunteers over 20 years and demonstrated considerable improvement for 91 diseases. Many of the diseases had over 40% of the patients go into complete remission, and over 80% had measurable improvement.
                Mark Hyman writes on 31 of Eat Fat Get Thin, that he used to prescribe low fat vegetarian diets for his patients, but new research forced him to change his recommendations. He says he is not married to a particular point of view. Mark has been given a major responsibility at the Cleveland medical center and they are building a new 18000 sq. ft building that will be devoted to functional medicine. Mark goes on quite a bit about David Ludwig and his research on obesity and fat-positively.
                Another great source of information is Dr. Greger and I check his posts daily for very useful information. He is a great guy with a great heart, but I think he has made some mistakes. He is married to a particular point of view when it comes to vegetarianism, and grains. A double blind crossover study of 61 non celiacs a year ago Feb. demonstrated increased brain fog , depression, intestinal bloating, intestinal pain, and canker sores from exposure to gluten-statistically significant. The same month Fasano , on biopsied intestinal linings, demonstrated 100% of patients had increased permeability from exposure to gliadin. -I think those two studies are the nail in the coffin on gluten and wheat in general ( even without the glyphosate ). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377866/
                http://www.ncbi.nlm.nih.gov/pubmed/25701700
                What we all have in common is bucking big pharma, big food, and a horribly corrupted government system. Hopefully I have not lost sight of that and made enemies, when I need friends.

                1. To be honest, I regard Wahls, Hyman and Ludwig with considerable caution. People making money from selling highly sensational diet books are not the most credible sources of information on nutrition and health, to my mind.
                  The two studies you mention are certainly interesting but your comment “I think those two studies are the nail in the coffin on gluten and wheat in general ( even without the glyphosate ).” seems to go far beyond what the evidence shows. For example, the second study only investigated the effect of gluten as opposed to gluten-containing foods. The first looked at the effects of gliadin (as opposed to gliadin-containing foods ) on tissue specimens in microsnapwells. I am much more swayed by the fact that people who eat wholegrains have lower mortality than people who don’t. And, as Berkeley notes, “Many studies have linked higher intakes of whole grains, including whole wheat, with a reduced risk of diabetes, heart disease and stroke, as well as improvements in blood cholesterol, blood pressure and blood sugar control.”
                  http://www.berkeleywellness.com/healthy-eating/nutrition/article/should-you-worry-about-wheat

                  I eat wholefoods, not gluten or gliadin, and I find the studies showing hard clinical endpoint benefits from eating wholegrain products compelling. The studies you cite merely explore the effects on biomarkers of isolated food components. I do not see why anybody would consider these to have superior clinical relevance to studies showing actual mortality and morbidity benefits from wholegrain consumption. Of course, for people who actually have allergies, intolerance or insensitivities this might be different, but the mortality and morbidity studies suggest that the great majority of us will benefit from wholegrain consumption.

                  1. Tom: As usual, I agree with what you say. I have a copy of The Wahls Protocol, and am not impressed. She provides very little data to support her plan, which includes (pg.s 202-209): “Add more fat…”, and “you are better off getting your EPA and DHA straight from animal sources..”, and “eliminate all grains, legumes, and potatoes…” and “limit fruit to one serving per day…” and “eat just twice a day and fast every night for at least twelve hours.”

                    However, in my job as a practicing family physician, I have learned to not be totally dismissive of some of the strange ideas my patients have about diet. Dr. Wahls certainly seems to have benefited from following her diet, in that her MS got much better, without using drugs. This is probably because she advocates eating lots of very healthy whole vegetables. I try to steer my patients to credible information — e.g. NutritionFacts.org, but I don’t dismiss them out of hand if they are totally wedded to some diet plan that I consider mainly unsubstantiated. I would lose some of my most intelligent and motivated patients!

                    Note to Fred, above: just because she is a doctor, doesn’t mean that Dr. Wahls won’t exaggerate and use unsubstantiated “protocols”.

                    1. More substantive than the ” unsubstantiated” ( clinical trials completed and more being done? ) may be the most valuable information a practicing physician can make use of ( IMHO ). – The Seignalet Protocol
                      So spending some time reviewing how Anne Seignalet and Dr. Dominique Seignalet ( daughters ) presented the data in their book and how Jacqueline Lagace ( PhD and ran a research lab for 17 years ) presented the same data. Jacqueline clearly distinguished the 23 diseases that responded negatively to the protocol ( still very valuable information to have ) , from the diseases that had only an average of 4 patients per disease, from the diseases that had an average of 55 patients per disease. Some remarkable recoveries in certain diseases. Of 237 with colitis 233 had complete remission. Of 72 with Crohn’s disease 62 had complete remission. Dr. Seignalet also found a way to collect and compare data on Alzheimer’s, myocardial infarction and cancer. He collected data on 1200 patients and compared to a control group of the same origin and age group, but who never had been on the specific diet. There were 30 cases of cancer in the control group and 3 in the diet group, 28 myocardial infarction in the control group and 5 in the diet group, and 30 cases of Alzheimer in the control group and 0 in the diet. Since Alzheimer’s is being considered a type of diabetes ( type 3- http://www.doctoroz.com/article/alzheimers-diabetes-brain) we may all benefit from mulling over these very valuable collections of data. ( including the clinical trials that Dr. Wahls has completed). We may also like to do some simple mind experiments and mull over a few facts like what foods raise the insulin the least (according to one chart eggs were the lowest ) , and how bread has a glycemic index more than 40% higher than regular table sugar. What are the implications of these sort of things from an evolutionary point of view?
                      My favorite mind experiment over the last few days has been imagining the foragers as they enter a new territory where none of the animals in the area have any experience with man. With an elementary spear or club these animals would have been easy picking. ( for the last 50,000-100,000 generations ). The aborigines of Australia will approach a herd of animals and by bending down and acting like they are eating the grass they can quickly get within just a few feet of the other animals in the herd.
                      Also spending some going through the different references Dr. Greger used from the references that Dr. Hyman used to reach complete opposite conclusions about omega 3. I am so far leaning about 80-90% toward Dr. Hyman because his descriptions are so much more comprehensive and he uses more recent research . But am trying to stay open and not get married to one idea or the other.
                      He devotes about 26 pages to fat and heart disease and Dr. Greger devotes 17 pages to how not to die from heart disease. Anybody can join me in comparing them. When they have time.
                      The study I feel so far is the most reliable is the one where the scientists supplied the patients with the food to eat. ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974193/ )

      2. The subject of fat is becoming more confusing for me. It seems there is alot of old information that considered saturated fat a problem for arteries having plaque and hear disease, now I see recent articles referring to good fat as healthy. In fact I had catherizations in 1973 and 1976 and my arteries were clean, no plaque but when I had a catherization in 2000 I had to have a triple bypass die to as much as 90% blockage.

        1. The problem is that the people making claims about old information about saturated fat are like the people trying to sell the Emperor’s New Clothes – long on claims and hype but short of actual substance. There is a lot of very iffy “information about nutrition and health on the internet and in sensational fad diet books. It is important to only use credible sources. There are major international and US reports on diet and health which are free to download. They set out all the evidence on which their assessments, conclusions and recommendations are based. They don’t cherry pick research, use only carefully selected statistics, repeat lies about dead researchers or base their conclusions on speculation while ignoring the mass of evidence to the contrary. Which is more than can be said for most of the sensational mass-market get-rich-quick diet books and crackpot websites out there. Try reading these:
          http://www.who.int/nutrition/publications/nutrient/en/
          http://www.dietandcancerreport.org/expert_report/index.php
          http://www.health.gov/dietaryguidelines/2015-scientific-report/
          http://www.nel.gov/evidence.cfm?evidence_summary_id=250189
          http://foris.fao.org/preview/25553-0ece4cb94ac52f9a25af77ca5cfba7a8c.pdf

          I have also come to regard this website as a highly credible source of nutritional information

          References to good fat have to be considered in the context of “relative to what” Yes, some fats appear healthy compared to eg trans fats, saturated fats and certain oils. But all this really proves is that they are less unhealthy than fats X, Y and Z.
          The fact is that we can get all the fats we need from whole foods. We do not need to consume concentrated fats in the form of eg butter, cheese, oils, fatty processed foods etc. My moring oatmeal is 15% fat by calories for example.

          As for heart disease, check Dr Esseltyn’s proven diet for reversing heart disease.
          http://www.dresselstyn.com/site/articles-studies/

          1. Thank you Tom, I have more research to do. Tell me, is adding some coconut oil to a smoothie a good idea or adding some avocado also good? I know Dr. Esselstyn says NO oil but other highly regarded Dr. don;t all agree either.

            1. Coconut oil is heavily hyped and marketed but I haven’t seen any good studies that show a real benefit. If you must use oil (and I see no need to use oils at all), there are less unhealthy alternatives. See the Harvard articles below. Personally, I would give it a miss.
              But you could add some coconut flesh if you want to cover all the bases. Whole avocado is probably OK, it is high in calories.
              http://www.health.harvard.edu/staying-healthy/an-avocado-a-day-may-keep-cholesterol-at-bay
              http://www.health.harvard.edu/heart-health/coconut-oil-supervillain-or-superfood
              http://www.health.harvard.edu/blog/the-type-of-fat-you-eat-matters-201509228333

            2. From what Ive learned, our cell membranes have fat sandwiched between two proteins, putting “bad fats” such as polyunsaturated fats (safflower, sunflower, and soybean oil) and saturated fats (found in red meats, eggs, coconut oil) gum up the system and produce either arichadonic (sp?) acid(saturated fat) or omega-6 fatty acids (vegetable oils), while plant-based ffoods such as broccoli have a small amount of “good” omega 3s. Why use crude oil and when you can use WD 40? Since moving to high carb, low fat, my blood sugar has stabilized downward.

                1. Had A!C done (see image), but it was a couple of years ago and leaned toward the high side. I have been taking Chromium Picolinate, 200 mg twice a day. Roobios tea also has a blood-sugar-stabilizing effect. Over the years I have spent thousands on supplements, but they will never beat a good diet. What’s really funny is that straight sugar products like Twizzles or Hot Tamales that have no added fat don’t seem to effect my blood sugar levels

                  1. Saul, that is funny, one of my favorites is Hot Tamales or anything with cinnamon. May the HT has cinnamon, good for high sugar. Mine 6.2 last year and will have the test in july. I checked my own fasting glucose, it was 97 lowest I ever had. Maybe a good sign for the A1c test.

        2. Ron there is a section in the new book by Dr. Mark Hyman titled: ” The Surprising Truth about Fat and Heart Disease” , pg. 88 – 104 that will answer your question. He has many references and goes into detail of most of the major studies and meta-analyses, including the big study in 2014 led by Dr Rajiv Chowdbury. Very basically it has been shown that the carbs are running the show. With omega3 ( which 90% of americans are deficient ), fiber and low carb, saturated fat is actually protective of heart disease. If you introduce high carb into the mix then everything just goes to hell and inflammation goes sky high.
          Also rest assured he is putting his money where his mouth is . On pg. 98 he says, ” I’ve put thousands of patients on a high-fat, low-carb diet and have seen for myself beneficial changes in all the important known risk factors for heart disease, including overall cholesterol profile, blood sugar, insulin, inflammation, liver function, hormones, and belly fat.”

          1. Fred, thanks for the info. I have alot of respect for Dr. Hyman who is at the Cleveland Clinic, where go. I know several others have nothing but positive comments on coconut oil and saturated fats. Much of this is new to those following the old. The only one, who also happened to also be a Clinic Dr. is Dr. Esselsten who still say’s NO oil. Here is his position, “NO OIL! Not even olive oil, which goes against a lot of other advice out there about so-called good fats. The reality is that oils are extremely low in terms of nutritive value. They contain no fiber, no minerals and are 100% fat calories. Both the mono unsaturated and saturated fat contained in oils is harmful to the endothelium, the innermost lining of the artery, and that injury is the gateway to vascular disease. It doesn’t matter whether it’s olive oil, corn oil, coconut oil, canola oil, or any other kind. Avoid ALL oil.” Fred, I guess controversies never end.

      3. Tom: Thank you for your astute comments about observational studies. I have a master’s degree in epidemiology (as well as an MD). The potential biases in observational or cross-sectional studies is an issue that is not easy for many people, including many doctors, to understand.

  10. Thanks very much for all your research. I’ve been vegan for 11 years now and I am still learning about the wonderful benefits of a plant based diet :)

  11. The aticle says there is benefit to flaxseeds at 2T per day. Dr. Greger, your daily dozen app recommends 1T. I’ve been adding 1T to my oatmeal every morning, and love it, but I can’t imagine adding 2T. Is 2T really necessary?

    1. One tablespoon of whole translates into 2 tablespoons ground. I spilled ,snoothie on ?y keyboard. Guess the ones that don’t work.

    2. Hi Marsha! Dr. Greger recommends 1 tablespoon of ground flaxseed per day as part of his Daily Dozen. A quick tip: try buying them whole – then when you’re ready to use, grind with a blender, coffee grinder, or spice grinder. If you eat flaxseed whole, they’re likely going to pass through you the same way without releasing the nutrients. Sounds like what you’re doing is adequate! (As long as they’re ground.) Hope this helps!

      1. Thanks! Yes, I use “whole ground flaxseed meal.” Happy to pay so I don’t have to grind! Sometimes I eat cold cereals that have flaxseeds in them, and I just try to chew it really well to grind the flaxseeds with my teeth. But I still add the ground flaxseeds just in case. I love this way of eating and tell everyone I come in contact with about “How Not To Die” (without being too overbearing, of course).

        1. That’s great! We’re happy to hear you’re as excited about “How Not to Die” as we are. Best wishes! :)

  12. No need to “treat” prediabetes when you can easily cure it or keep from getting it to begin with. And for those early postings argueing about various doctors diets and whether they work or not…its quick easy and simple to just try a program for a few weeks or months and really see how it works…no need to play dueling studies or hypothesis, just try it and know for sure!

    my results: https://www.drmcdougall.com/forums/viewtopic.php?f=13&t=35090

    my one year journal with all the daily details: https://www.drmcdougall.com/forums/viewtopic.php?f=21&t=27969

    geo

  13. A diet containing whole grains with more fibre will certainly be better than more processed grains with less fibre or a diet that is high in sugars, however once you have diabetes eating high levels of whole grains will likely raise blood glucose and insulin levels and exacerbate the condition. Just like any constant exposure to drug like alcohol, nicotine or caffeine, constant exposure to high levels of insulin will also lead to insulin resistance.

    This list of foods has been helpful for our family (my wife has type 1 and I have a family history of type 2 on both sides) to manage blood sugar and improve insulin resistance. The saturated fat levels and cholesterol levels of these foods are within the recommended limits while keeping the dietary insulin load low.

    https://optimisingnutrition.com/2015/04/06/optimal-foods-for-blood-sugar-regulation-and-nutritoinal-ketosis/

  14. God bless Dr. Ogidi for his marvelous work in my life, I was diagnosed of Diabetes since 2012 and I was taking my medications, I wasn’t satisfied i needed to get it out of my system, I searched about some possible cure for Diabetes and i saw a comment about Dr. Ogidi, how he cured (Diabetes 2) with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine through UPS SPEED POST. I took the medicine as prescribed by him and after some weeks later i was cured from Diabetes, Dr. Ogidi truly you are great. Do you need his help also? Why don’t you contact him through Ogidiganherbalhome@gmail.com OR Call +2347052973721

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